Figure 1. A. Esophagogram of a 79-years-old female with sigmoid megaesophagus and bird sign at the GEJ (Dr. N. Eleftheriadis’ case). B-D. After POEM GEJ is open. E. Good closure of mucosal opening by clips after completion of myotomy.

Patient mobilized the same day and discharged one day after POEM. She received soft diet for one week and then normal diet, while until now she can eat normally, with excellent quality of life many years after POEM.

Figure 2. POEM stages in a 79-years-old male (from Dr. Nikos Eleftheriadis series) with 45-years history of achalasia type III, with sigmoid megaesophagus and failure of repeated balloon dilatations. Figures show very thick circular muscle layer, which however, Dr. Nikos Eleftheriadis myotomized successfully and completely by POEM technique during gastroscopy.

Patient mobilized and drank the same day after POEM and discharged one day after. He received soft diet for one week and normal diet thereafter, while until now (four years after POEM) eats normally, he is fine, with excellent quality of life. Of particular interest in this case was, that the patient, one day after POEM, travelled from Athens to North Greece Kastoria (7hours by car), without problem during winter.